Association Between Method of Cerebral Protection During Neonatal Aortic Arch Surgery and Attention Deficit/Hyperactivity Disorder

作者：Sistino Joseph J^*; Atz Andrew M; Ellis Charles Jr; Simpson Kit N; Ikonomidis John S; Bradley Scott M

来源：Annals of Thoracic Surgery, 2015, 100(2): 663-670.

DOI：10.1016/j.athoracsur.2015.04.119

Background. Neonates undergoing repair of the aortic arch are at risk for adverse neurodevelopmental outcomes, including attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to compare the effect of deep hypothermic circulatory arrest versus regional cerebral perfusion on the long-term outcome of ADHD.
Methods. This study is a cross-sectional observational study of ADHD in children who underwent neonatal aortic arch surgery. Attention Deficit/Hyperactivity Disorder-IV surveys were used to determine the prevalence of ADHD. Review of the medical records was performed to determine the primary method of cerebral protection and to extract related surgical variables.
Results. Surveys were sent to parents of 134 children, with 57 surveys completed (43%). The percentage of children classified as having ADHD was 44%. Children with a diagnosis of interrupted aortic arch had the highest prevalence of ADHD (85%). Multivariate analysis demonstrated that interrupted aortic arch was associated with an increased ADHD inattention score (p < 0.01), and a decreased Child Health Questionnaire-50 psychosocial score (p < 0.01). Low Child Health Questionnaire-50 psychosocial summary scores are associated with increased behavioral problems and are lower in patients with ADHD.
Conclusions. Attention deficit/hyperactivity disorder is common after neonatal aortic arch surgery and may be primarily related to genetic predisposition. We found insufficient evidence to show that either deep hypothermic circulatory arrest or regional cerebral perfusion decreased the risk of ADHD.

• 出版日期2015-8